Trigeminal schwannoma is a rare cause of
cerebellopontine angle tumour. This case report
of a 65-year-old lady presented with ipsilateral
facial numbness and instability. She was finally
diagnosed to have trigeminal schwannoma after
seeking multiple medical consultations with her
doctors. This case report highlights a rare cause
of cerebellopontine angle tumour.
Aging population will be an inevitable phenomenon around the globe. This study aimed to
assess the quality of life and its associated factors among the elderly population in rural areas of
Kudat, Sabah. A community based cross-sectional study was conducted among elderly aged 60 and
above living in Tambuluran Area of Kudat. Quality of life was assessed using WHOQOL-BREF
questionnaires. Socio-demographic data of the elderly, perceived morbidities and utilization of health
services were collected. Independent sample t-test was used for data analysis. A total of 165
respondents participated in this study with a mean age of 71.42±6.50. The mean WHOQOL-BREF
score was 65.20 ±11.49. Mean scores for physical and psychological domains were lower than
average. Age, marital status, educational level and perceived morbidity were associated significantly
with QOL. In conclusion, QOL was generally average among elderly in rural areas of Kudat.
Therefore, interventions should place emphasis on physical and psychological aspects of life among
these aged population.
Obesity is a prevailing health issue and has been recognized as a threat in public health worldwide.
Rural setting is no longer a barrier to the epidemic of obesity as previously thought. This crosssectional
study aimed to determine the risk factors and associated co-morbidities of obesity among
adults aged 18 and above in rural community of Kudat, Sabah. 28.2% of respondents were found to be
obese with female predominance (54.9%). Older age, formally educated, ever-drinkers and high
systolic blood pressure were associated with obesity. Various forms of interventions should also
involve the rural area to close the disparity of health.
Myasthenia gravis, the most common autoimmune
neuromuscular disorder, is characterised by
muscle weakness and fatigability. A 23-yearold-lady
with background history of breathing
and swallowing difficulty for six months was
presented with respiratory distress to the hospital
which is without an in-house neurology service.
Her diagnosis remained a challenge as patient
presented as an emergency without detailed
medical history. She was subjected to bedside ice
pack testing and subsequently managed along the
diagnosis of myasthenia crisis. She responded to
the treatment and survived the critical period. So,
diagnosis of myasthenia gravis by ice pack test
and managing a case of myasthenic crisis would
be possible in limited heath care setting.
Wegener’s granulomatosis (WG) is a necrotizing
granulomatous inflammation. A 40-year-old lady
of Malay descent presented with unresolving
bilateral painful red eyes for three weeks. Clinical
examination revealed that best corrected vision
acuity of 6/9 for both eyes. Slit lamp examination
revealed diffuse scleritis. Other Investigations
result like UFEME blood cell: 2+, C-reactive
protein 70.06 mg/L and ESR of 125 mm/h
suggestive on acute inflammations. Connective
tissue screening revealed cytoplasmic ANCA
was positive and was supported by Anti-Serine
Protease3 (PR3) 68. All the investigation results
revealed that she had Wegener’s granulomatosis
with ophthalmology manifestation in the
form scleritis. Patient was treated with guttae
Maxidex QID to reduce cells that present in
anterior chamber and oral ibuprofen 400 mg
thrice daily. Subsequently, oral prednisolone
and oral cyclophosphamide with oral Bactrim
were commenced. Patient responded well and
redness resolved. There are many differential
diagnoses for chronic conjunctivitis but to rule
out connective tissue disease should be one of the
primary differential diagnoses in young female.
Oral immunosuppressive and Trimethoprim/
Sufmethoxazole (Bactrim) were been found
beneficial and symptoms were resolved. Wegener’s
granulomatosis is a great mimicker as exemplified
in this case. This disease can be misdiagnosed and
maltreated as conjunctivitis. Thus, the authors
wish to emphasize that WG is one the differential
diagnoses that need to be considered in a person
with bilateral scleritis.
Trimethoprim-Sulfamethoxazole (TMP-SMX)
or Co-Trimazole is the treatment of choice for
meliodosis. A 52-year-old man presented with
generalized body weakness with reduced appetite.
He had bradycardia on examination. After
investigations, he was diagnosed as hyperkalaemia.
He had life-threatening hyperkalaemia treated
with Trimethoprim-Sulfamethoxazole (TMPSMX)
as part of the eradication therapy for
Meliodosis. Urgent haemodialysis was done. There
were changes done for his meliodosis treatment.
This case wished to highlight the importance of
considering hyperkalemia in patient treated with
Trimethoprim-Sulfamethoxazole especially when
risk factor for hyperkalaemia is present.
An Objective Structured Clinical Examination (OSCE) is a tool of assessing the clinical school often used
in the education system of the healthcare system. Traditional Oral Examination (TOE) is also a clinical
examination where students are being tested by an examiner panel (1 or 2 members) on their clinical
activities and knowledge. It is designed to objectively test competence in skills such as history taking,
clinical examination, communication and clinical procedures. The Faculty of Medicine and Health Sciences
of Universiti Malaysia Sabah (UMS) also use OSCE for assessing clinical students. The aim of this study
was to compare the performance between the traditional oral examination (TOE) and OSCE among
undergraduate medical students. Study populations were the 3rd year MBBS students of the Faculty of
Medicine and Health Sciences of Universiti Malaysia Sabah (UMS). Number of students was 87. All
students underwent traditional oral examination after finishing a 2 months module. The same students
participated in the OSCE on the same day evening. Scores of each student were collected. Mean of the
scores were calculated. P value was measured by Student’s t test to evaluate the significant difference
between both the variables (traditional examination mean and OSCE mean) at 5% confidence interval (CI).
P-value was 0.00015 in 5% confidence level in two tailed hypotheses. As the value was less than 0.05 so
null hypothesis was rejected and alternate hypothesis was accepted. There was significant difference between the means of both the examinations. So it could be concluded that students’ performance was
significantly better in the OSCE over the traditional oral examination.
Calcification of costal cartilage increases with age and it is rare before the age of thirty years. Early
onset of costochondral calcification can be associated several endocrine and metabolic diseases,
following a trauma, infections, malignancies or due to genetic factors and very rarely idiopathic. Our
case exemplifies premature calcification of costal cartilages. The patient was a 20-year-old lady,
referred to endocrine clinic in UMS polyclinic, Kingfisher, University Malaysia Sabah for evaluation
of metabolic and endocrine causes of premature costochondral calcification. Physical examination
findings were normal except mild tenderness over the left lower lateral part of the chest. Investigation
results were inconclusive to detect any underlying endocrine, metabolic or inflammatory conditions.
Chest X-Ray revealed bilateral calcification of the 10th, 11th and 12th costal cartilages and was diagnosed
as idiopathic calcification of costal cartilage. Only analgesics were given as treatment and the pain
subsided after few days.
Synovial Sarcoma is a rare malignancy. It presents in adolescents and young adults. It occurs in soft tissue
of extremities usually near to the large joints, heart, lung, mediastinum, head and neck. A 23-year-old
female presented with a big hard fixed swelling in right supraclavicular region for 15 years. X-Ray chest
posterior-anterior view presented Homogenous opacity in upper lobe of right lung. USG of neck showed
large heterogeneous lobulated almost avascular solid mass in right side of root of neck and anterior upper
mediastinum may be associated with Schwannoma/ paraganglioma/soft tissue sarcoma. Spindle cell
lesion was reported by FNAC. MRI showed large slightly lobulated mass along right side of root of neck
and right side of superior mediastinum. A large soft tissue density mass along right side of neck and
superior mediastinum was found in CT scan. Surgical excision was done successfully. Histopathological
examination revealed spindle cell tumor favoring synovial sarcoma in the neck tissue and metastatic
spindle cell tumor in the lung lesion.
It is important to prepare the nursing students to be confident and able to interact with the patients,
colleagues, doctors and other staff because the nature of nursing work included a high degree of personal
and group interaction. Continuous communication and interaction in nursing work are some of the
important factors for self-esteem among nurses. Self-esteem affects the relationship between job roles and
job satisfaction as well as the link between work performance and work roles conflict. The objective of this
study is to examine the effects of low self-esteem on clinical performance among first year nursing students
at private nursing college in Kota Kinabalu, Sabah. A descriptive qualitative study was conducted among
10 first year nursing students in one of the private nursing college. Data was collected through one to one
interviews using semi-structured questions. The interview question was structured based on observation
and literature review. The design is ideal because it facilitate the collection of data from a small number of
participants through personal interview. The collected data was transcribed into verbatim and analysed by
identifying the themes via coding and categorization. The results showed there are two main themes
emerged from the study: Defensive behavior and poor communication as the effects of low self-esteem on
the students’ clinical performance. As conclusion from this study, defensive behavior and poor
communication and are the obvious effects of low self-esteem among the first year nursing students in a
private nursing college. This study revealed the needs to equip the students with more conducive learning
environment facilitate suitable motivational and mentoring approaches and practice good communication
skills. Future research suggested, extends the study to the public nursing college for outcomes comparison
and evaluation.
An Objective Structured Clinical Examination (OSCE) is now a well-recognized modern type of
examination often used in faculties of medicine and health sciences all over the world. Though the
assessment tool has been designed to assess different types of clinical skill but this is evident that student
performance are not the same in different types of stations. The aim of this study was to evaluate the
performances in different types of OSCE stations among undergraduate medical students. Three types of
stations were set in this cross-sectional study. They were clinical reasoning, history taking and procedure
performing. On the examination day all the students had attended 3 stations for procedure, 4 stations for
clinical reasoning and 3 stations for history taking. The scores were collected and transferred to excel
spreadsheet. Mean score of each types of modules were calculated. Statistical difference between all three
means were measured by one-way ANOVA F-test. F was 7.2 and p-value was 0.001304. The result was
significant at p
In this study parallel scales were constructed to use to measure the levels of HIV-related stigma towards people living with HIV (PLHIV) in populations with different backgrounds in Sabah. The study also explored the components of stigma within the population. We found that there were three principle components of HIV related stigma: “Interpersonal distancing,” “Shame and blame,” and “Positive opinions about PLHIV”. The scales constructed showed adequate internal consistency (Cronbach’s Alpha of 0.69 to 0.85) in all samples. The medical students and people with more knowledge about HIV had significantly lower levels of all three factors of personal stigma. Regarding HIV-related knowledge, the non-medical university students and the rural community group were found to have poor knowledge of HIV transmission and prevention. This scale can be used by researchers or public health officials who wish to study HIV related stigma or to evaluate the impact of stigma interventions in the local context.
Study site: Universiti Malaysia Sabah; Rural Medical Education Centre, Sikuati, Kudat, Sabah, Malaysia
Learning anatomy is the basic and essential component of medical study when students start to learn in medical career. Since five hundred years ago, the human cadaver has been used as the silent mentor for students in learning anatomy. Later, pre-dissected specimens were used in addition to hands-on dissection of human cadaver. Current advances promote the use of anatomical models as well as plastinated specimens. This study focused on analyzing the preference of students towards different learning modalities available for anatomy teaching. It was conducted on first year medical students at the Faculty of Medicine and Health Sciences, University Malaysia Sabah (FPSK, UMS). A total of 76 students (27 males and 49 females) participated in this study. Out of 76 students, 57 (75%) students preferred using human cadaver for anatomy learning. Four students (5.3%) opted for plastinated
specimen while 15 students (19.7%) chose the plastic model. Knowledge gained in learning Anatomy was said to be easier from cadaver (67.1%), followed by plastinated specimen (35.5%) and plastic models (52.6%). In the present study, 97.4% responded that plastic model was easier to apply their knowledge in objective structured practical examinations. The present study found that using cadaver was still favoured by medical students. Further studies are required to determine the preference between hands-on cadaveric dissections versus pre-dissected specimens.
Escherichia coli (E. coli) is one of the most frequent causes of many bacterial infections especially
gastroenteritis in developing countries. It is also used as an indicator for faecal pollution in the
surveillance of bacteriological quality of drinking water. This study was conducted to determine the
survival of E. coli in water at room temperature (27oC). E. coli which is cultured in Lactose Peptone Broth
was inoculated into 8 bottles each containing 10 millilitres of distilled water. They were kept at 27oC.
Starting from the day 1, ten-fold dilutions were made from each bottle number and E. coli count was
done from each dilutions by using pour plate method. The colony forming unit/ millilitre (CFU/ml) was
calculated. The same procedure was carried out from bottles number 2 to 8 from day 2 to day 8
consecutively. CFU/ml of E. coli in dilution 10-5was markedly decreased from 3.9 x 106
in day 1to 0 in
day 8. The findings suggest that if the water is contaminated with low number of E. coli, it can be
eliminated by keeping water at room temperature for only few days.
Antimicrobial activity of ethanolic extract of Aloe vera were observed against Staphylococcus
aureus, Staphylococcus pyogenes, Staphylococcus saprophyticus, Streptococcus pneumoniae
and Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae . Aloe vera leaf gel
was used for ethanolic extraction.Zones of inhibition in millimeter was used to measure the
antimicrobial effect. Antimicrobial susceptibility test showed that ethanolic extract has growth
inhibitory effects against the tested pathogens. Ethanolic extract of Aloe vera has growth
inhibitory effects against tested pathogen seen by antimicrobial susceptibility testing.
Antenatal (AN) care is vital for all pregnant women and for reduction of maternal mortality and morbidity. AN care knowledge and specific AN care practices are some of the crucial components of what determines effective AN care. In developing nations, the health of pregnant women can be even more sensitive to these factors. Objectives of this study was to assess the antenatal (AN) care practice and pregnancy outcome of ever-married women aged 18 to 49 years old having at least one pregnancy experience ,residing in kampongs of Sikuati area, Kudat between March to December 2015. Cross–sectional descriptive study, non-probability convenient sampling method was used and 150 eligible participants were interviewed through face to face by trained interviewers using a semi-structured questionnaire and their knowledge of AN care, their AN care practices and outcomes and complications of their pregnancies were recorded. 99% of all the women received AN care, and 64% of the women received essential AN care practice (AN visit of minimum 4 times). The study revealed that overall knowledge amongst the women with good knowledge was 48% and low knowledge was 52%. Despite this, it was found that low knowledge of AN care was associated with essential AN care practice. Additionally, AN care practices, assessed through timing of first AN care visit and frequency of visits, was not significantly associated with pregnancy complications. Despite these results, outcomes were good and all complications were properly and successfully addressed. This may reflect the effectiveness of current programs in place promoting importance of AN care and delivery practices. Maintenance of current programs with targeted interventions to address low knowledge level and the low level of compliance with essential AN care completed are recommended..
The Emergency Department (ED) provides treatment for acutely ill patients in need of urgent medical attention. Despite the availability of the primary care unit ‘Klinik Kesihatan’, where non urgent patients should be treated, Malaysia’s public hospitals still need to deal with overcrowding of non-urgent patients in ED. The main aim of the study was to assess the willingness of non-urgent patients to be redirected to Klinik Kesihatan. This was a cross-sectional study conducted at Hospital Tuaran Emergency Department, Sabah. Non-urgent patients were interviewed using a questionnaire, to find out the purpose of their visit to Emergency Department. A total of 318 non-urgent patients out of 457 patients were interviewed during the study duration. 41 respondents (12.9%) were willing to be redirected towards a Klinik Kesihatan. No associated factors were found when compared with the unwilling to be redirected group. Among 277 respondents who rejected redirection to Klinik Kesihatan, 70.4% agreed to pay a surcharge to be treated in the Emergency Department and there was no association found with the employment status (p= 0.391). Most patients were not willing to accept redirection to a Klinik Kesihatan and would prefer to visit the Emergency Department despite knowing that their condition or illness is one that does not require emergency treatment. Social media, advertisements and pamphlets must be made available to educate patients on the proper use of the Emergency Department.
Out of bacteria which cause food –borne infections, enterohemorrhagic Escherichia coli (EHEC) is
well known to be pathogen causing serious outbreaks. The first outbreak of EHEC infection occurred
in 1982 was due to ingestion of hamburger at restaurant. A rare Escherichia coli serotype, 0157:H7
was isolated at that time and the following outbreaks were mostly due to this serotype. However, O26,
O111 and O104 were also responsible for EHEC outbreaks. Enterohemorrhagic E. coli is an important
food and water-borne pathogen. Verotoxins (VTs) produced by this pathogen causes painful
hemorrhagic colitis along with major complications of hemolytic uremic syndrome (HUS). The
morbidity and significantly high mortality and enormous economic loss are problematic to the health
care administrators and EHEC infection is a serious public health issue. Another factor which makes
it high transmissibility is the low infectious dose. The German O104:H4 epidemic was caused by the
pathogen carrying a combination of virulence genes derived from two well-known pathogens, EHEC
and enteroaggregative E. coli (EAEC). There is a possibility that two mobile DNA elements can occur
again in this versatile pathogen. In this article, some aspects of EHEC infections which were
established but not well known to the medical personals were explained to get understanding of why
this infection should not be overlooked and should be under surveillance.
Cigarette smoking is considered as the symbol of adulthood and as a friend during stress and loneliness. The developing countries in South Asia where the largest segment of the population is comprised of adolescents are more susceptible to smoking epidemic and its consequences. A cross sectional survey among 304 randomly selected medical students was carried out to determine their smoking habit of a selected medical college in Dhaka, from 1st October to 31st December 2014. The respondents were from 16 to 20 years of age, with mean (±SD) of 16.8 (±1.9) years. Among them (including 28 girl students), 96(31.5%) were non-smokers. The remaining 208(68.4%) were smokers, among them 43(20.6%) were regular smokers, and 165(79.3%) were occasional smokers. All 28 female students were non-smokers. Regarding duration of smoking, 42(20.2%) respondents smoked for less than 6 months, 64(30.8%) for 6 months to 1 year, 88(42.3%) for 1 to 4 years, 11(5.3%) for 5 to 10 years and a least 3(1.4%) smoked for more than 10 years. Thirty six percent of current smokers smoked more than 10 sticks per day compared
with thirty percent who smoked 6 to 10 a day. Significantly more users knew that it causes tuberculosis, heart attack, cancer and development of hypertension. Overall, students’ major sources of information were doctors (69.7%), medias (47.7%), parents (9.2%) and friends (3.3%). As the prevalence of smoking among medical students was found very high hence, the multi-pronged intervention strategy is needed to tackle the problem. Anti-tobacco education and awareness should be adopted in the curriculum of schools and colleges. All forms of tobacco advertising and promotional activities should be banned, and parents should be encouraged to adopt more responsible attitudes toward smoking in the home.
Ocular trauma is a significant health problem in paediatric age group. This study is to evaluate the
demographics, etiology, management and visual outcome of paediatric ocular trauma in Sabah.
This is a retrospective review of all ocular trauma occurring in the paediatric age group from age
12 years old and below from January to December 2014 at Hospital Wanita Dan Kanak-Kanak,
Sabah. Medical records were reviewed and the data was examined based on Birmingham Eye
Trauma Terminology (BETT) system. Incomplete case notes were excluded from the study. A total
of 37 cases were accumulated during the study period. All the paediatric ocular trauma cases were
admitted and accounted for 13.4% of the total paediatric eye ward admission. However, 4 cases
were excluded from the study as the medical records were incomplete. There were 26(78.8%) males
while 7(21.2%) female children with a ratio male: female of 3.7: 1. There were 31(93.9%) unilateral
ocular injury cases while only 2(6.1%) bilateral injury caused by chemical injury. The most
common type of ocular trauma was closed globe injury totaling 24 (72.7%) cases. Trauma caused
by blunt object contributed to the highest mode of injury 15 (45.5%) of cases. Open globe injuries
which had poor visual outcome accounted for 9 (27.3%) cases. Most of patients required surgical
treatment 21(63.6%) while 12(36.4%) cases treated non-surgically. In conclusion, ocular trauma
was more common in male and pre-school age group. The main aetiology was blunt injury. Most
of the cases treated surgically. Poorer visual outcome was observed in open globe injury.